Depression or Psychosis Predicts Perinatal Recurrence of Bipolar Disorder

pregnant woman at doctor
pregnant woman at doctor
Investigators sought to determine clinical predictors to identify risk for perinatal recurrence in women with bipolar disorder.

A patient’s history of affective psychosis or depression is a principal prognostic tool for perinatal recurrence of bipolar disorder among women, according to a study published in The British Journal of Psychiatry.

This study included 887 participants, all of whom were female, had given birth, and had been diagnosed with bipolar disorder. The most effective prognosticator of perinatal recurrence proved to be the patient’s background of affective depression (odds ratio [OR] 3.6; 95% CI, 2.55-5.07) or psychosis (OR 8.5; 95% CI, 5.04-14.82). For women with no history of mood or psychotic episode during their first pregnancy, the risk for such an occurrence in their second pregnancy was 31% (95% CI, 26.4-35.9%), with 7% experiencing psychosis after childbirth. Those who had experienced an episode during their first pregnancy were at a significantly higher risk (55%; 95% CI, 50.2-60.1) during their second pregnancy (P <.0001).

Participants were gathered both systematically (25.7%) and non-systematically (74.3%). A semi-structured interview (Schedules for Clinical Assessment in Neuropsychiatry), review of case notes, and questionnaires were used to collect information on participants. Reinforcement learning trees, conditional permutation random forests, and backwards stepwise logistic regression were employed to select clinical predictors. Contingency tables aided in calculating the conditional probability of a psychotic or mood episode during the second perinatal period.

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The study researchers conclude, “[previous] perinatal history of affective psychosis or depression is the most important predictor of perinatal recurrence in women with bipolar disorder and can be used to individualise risk assessments.”


Di Florio A, Gordon-Smith K, Forty L, et al. Stratification of the risk of bipolar disorder recurrences in pregnancy and postpartum. Br J Psychiatry. 2018; 213(3):542-547.